Weight loss in bariatric surgery patients
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CE: Namrta; YCO/300605; Total nos of Pages: 6;
YCO 300605
REVIEW
CURRENT
OPINION Cognitive behavioral therapy and predictors of
weight loss in bariatric surgery patients
Linda Paul a, Colin van der Heiden b,c, and Hans W. Hoek d,e,f
Purpose of review
Bariatric surgery is the most effective treatment for morbid obesity. However, 20–30% of patients
undergoing bariatric surgery experience premature weight stabilization or weight regain postoperatively.
We report on the recent literature of predictors of weight loss and the efficacy of cognitive behavioral
therapy (CBT) in bariatric patients.
Recent findings
Preoperative disordered eating behaviors do not appear to be significantly predictive of postoperative
weight loss. Postoperative disordered eating behaviors, eating disorders, and depressive symptoms have
been found to be associated with less optimal weight loss results. Recent studies show that CBT can
contribute in reducing disordered eating behaviors and depressive symptoms. Some studies also show that
pre and postoperative CBT interventions can promote weight loss. New applications of CBT such as by
telephone, internet, or virtual reality might contribute to more accessible and low-cost treatments for the
large group of bariatric patients worldwide.
Summary
CBT seems to be effective in reducing risk factors for weight regain after bariatric surgery, such as
disordered eating behavior and depression. Controlled studies with long-term follow-up and larger sample
sizes are needed to investigate the long-term effect of CBT interventions on weight loss results and
psychological well-being.
Keywords
bariatric surgery, cognitive behavioral therapy, obesity, predictors, weight loss
INTRODUCTION and improvement of psychological functioning
The rising prevalence of obesity in many countries after surgery. However, 20–30% of patients experi-
has been described as a global pandemic [1]. If this ence suboptimal or adverse postoperative results
trend continues, by 2025 global obesity prevalence such as premature weight stabilization or weight
will reach 18% in men and surpass 21% in women regain [7,8]. Medical comorbidities and complica-
[2]. Obesity is defined as a BMI greater than or equal tions after surgery can play a role in these negative
to 30 [calculated as weight (kg)/height (m2)]. Obe- outcomes. Also the type of surgical procedure influ-
sity is not an eating disorder according to diagnostic ences the weight loss result [9]. Apart from these
and statistical manual of mental disorders-5. How- somatic and surgical factors, psychological aspects
ever, it is a harmful health condition, which globally have an effect on surgery outcomes as well, such as
causes many more disability adjusted life years than
eating disorders do [3,4]. Morbid obesity – defined a
PsyQ, Parnassia Psychiatric Institute, The Hague, bPsyQ, Parnassia
as a BMI of at least 40 kg/m2 – is a very serious health Psychiatric Institute, Rotterdam, cDepartment of Psychology, Education
condition with corresponding increases in obesity- and Child Studies, Erasmus University Rotterdam, Rotterdam, dParnassia
Psychiatric Institute, The Hague, eDepartment of Psychiatry, University
related morbidity and associated health costs [5].
Medical Center Groningen, University of Groningen, Groningen, The
Globally, the prevalence of morbid obesity is 0.64% Netherlands and fDepartment of Epidemiology, Columbia University
(95% confidence interval: 0.46–0.86) in men and Mailman School of Public Health, New York City, New York, USA
1.6% (1.3–1.9) in women [2]. Correspondence to Linda Paul, MSc, PsyQ, Parnassia Psychiatric Insti-
Bariatric surgery is the most effective treatment tute, Lijnbaan 4, NL-2512 VA, The Hague, The Netherlands.
for morbid obesity and leads to more weight loss Tel: +31 88 357 3032; e-mail: l.paul@parnassiagroep.nl
compared with nonsurgical treatment [6]. The Curr Opin Psychiatry 2017, 30:000–000
majority of patients experience excess weight loss DOI:10.1097/YCO.0000000000000359
0951-7367 Copyright ß 2017 Wolters Kluwer Health, Inc. All rights reserved. www.co-psychiatry.comCE: Namrta; YCO/300605; Total nos of Pages: 6;
YCO 300605
Eating disorders
PREDICTIVE AND RISK FACTORS
KEY POINTS
In search for predictors and risk factors for weight
Postoperative and not preoperative behaviors predict loss and psychological well-being after bariatric sur-
weight loss results. gery various factors have been investigated. These
factors concern a variety of psychiatric symptoms
CBT seems to be effective in reducing risk factors for
weight regain after bariatric surgery, such as and disorders (e.g., depression), dysfunctional
disordered eating behavior and depression. Whether behaviors (e.g., disordered eating), presurgical
this also promotes long-term weight loss results needs weight, and variations in presurgical preparatory
further research. procedure (e.g., mandatory weight loss). Reviews
from 2014 addressing predictive and risk factors will
New applications of CBT such as telephone, internet or
virtual reality-based might contribute to more be discussed first, followed by a presentation of
accessible, lower cost treatments for the large group of recent studies.
bariatric patients worldwide. In 2014, Wimmelmann et al. [20] reviewed stud-
ies on psychological predictors of surgical weight
loss. Results regarding the predictive value of severe
binge eating appeared to be inconclusive, which
depressive, anxiety, and eating disorders, but also could be related to differences in study design
disordered eating behaviors such as emotional eat- and assessment of binge eating. Personality and
ing and loss of control over eating [10–14]. The moderate psychiatric comorbidity were not the pre-
addition of psychological treatment to bariatric sur- dictors of postsurgical weight loss, whereas cogni-
gery might contribute to optimizing long-term tive impairments and severe psychiatric disorders
weight loss and psychological well-being by reduc- appeared to be negative predictors of weight loss.
ing psychological risk factors and promoting A review by Meany [21] of 15 studies on binge
healthy lifestyle. eating, binge eating disorder (BED), and loss of
Most psychological interventions for bariatric control over eating showed that these were associ-
surgery patients include behavioral life style com- ated with suboptimal outcomes in terms of less
ponents like healthy eating behavior and physical weight loss and more weight regain in the post-
activity. In addition to behavioral interventions, operative phase.
cognitive behavioral therapy (CBT) consists of In line with these findings, a review of predictors
techniques to identify and modify dysfunctional of postoperative weight loss [14] also concluded that
thoughts. Interventions may be applied pre or various postoperative disordered eating behaviors
postsurgery. The research field for psychological such as BED, loss of control over eating, and emo-
treatment in bariatric surgery patients is relatively tional eating were associated with poorer weight
new, so empirical support is still scarce. In a system- outcomes. Also, life style factors such as physical
atic review and meta-analysis of studies conducted activity and adherence to postoperative diet recom-
until 2013 Rudolph and Hilbert [15] examined mendations predicted weight loss.
the effects of various postoperative behavioral life- In the following, we will describe new studies
style interventions, including eight studies on CBT. which have been published since these reviews. In a
Their review showed that weight loss in patients first cross-sectional study on maladaptive eating
in the treatment group was larger than in the behavior and weight loss by Conceição et al. [10] a
usual care or no treatment groups in 13 out of group of preoperative bariatric surgery patients
16 studies. However, because of uncontrolled and two postoperative groups (respectively, 2 years postoperative) were compared. Loss
interventions, generalizability is limited. In recent of control over eating was found to be present in
years, several randomized clinical trials (RCTs) on 26.7% of the patients in the preoperative phase, in
CBT in bariatric surgery patients have been con- 11.8% of patients within the first 24 months after
ducted, showing promising results on reducing surgery and in 16.9% of patients after 24 months.
disordered eating behavior and promoting weight Loss of control was associated with poorest weight
&
loss [16,17,18 ,19]. loss outcomes, most weight regain, highest BMI, and
The article provides an overview of the out- most psychological distress, specifically in the long
comes of studies on predictors of postsurgical weight run. In a second cross-sectional study by the same
loss since 2014. Also current knowledge regarding research group [11] a preoperative group and three
the effectiveness of CBT in bariatric patients is out- postoperative groups (6 months, 1 year, 2 years
lined, as well as the development of new treatment postoperative) were assessed. The presence of mal-
applications. adaptive eating behaviors was found to increase as
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Cognitive behavioral therapy Paul et al.
&
time progresses after bariatric surgery, and to be Hindle et al. [27 ] reviewed 39 studies into early
associated with weight regain. This was especially postoperative variables and later weight loss and
true for picking and nibbling (unplanned and repe- found that a better early postsurgical weight loss
titious eating of modest amounts of food). In a was the most predictive factor of successful weight
&&
longitudinal study, Conceição et al. [22 ] found loss in the period up to 24 months postsurgery.
that the pre and postoperative frequency of prob- To sum up, results of studies into preoperative
lematic eating behaviors was comparable (37.7 and predictors for weight loss after bariatric surgery have
45.9%). However 43.5% of patients stopped disor- been inconclusive. It appears that postoperative
dered eating preoperatively. Postoperatively 39.5% behaviors influence postoperative weight loss more
of patients developed problematic eating behaviors. directly than preoperative factors. Especially post-
Whereas preoperative disordered eating was not a surgical disordered eating behaviors, eating disor-
significant predictor for postoperative weight loss, ders, and depressive symptoms have been found to
postoperative disordered eating predicted worse be associated with less optimal weight loss results.
weight loss outcomes. These results highlight the importance of continu-
In the Longitudinal Assessment of Bariatric Sur- ous and long-term monitoring of these risk factors
gery-2 study Mitchell et al. [12] examined eating and behaviors postoperatively and early interven-
behaviors and eating disorders before bariatric sur- tion in case of stagnation of weight loss. Also early
gery in a large sample of 2266 participants. Disor- postoperative weight loss predicts better medium-
dered eating behaviors, such as skipping breakfast term weight loss (CE: Namrta; YCO/300605; Total nos of Pages: 6;
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Eating disorders
physical activity contributes to physical and mental eating, and mood and anxiety symptoms at
health-related quality of life preoperatively. Unfor- posttreatment.
tunately, no postoperative measurement has been The online and smartphone application of CBT
conducted, nor was weight loss included as outcome is currently being investigated in Canada and
measure. This makes it unclear whether these results Portugal [31,32]. These programs may contain a
were retained after surgery and whether this inter- CBT-based self-help manual and psychoeducation,
vention also improved postsurgical outcomes. a feedback messaging system, and scheduled chat
Marcon et al. [19] compared the relative efficacy sessions with a psychologist and are aimed at train-
of preoperative exercise groups with and without ing relevant skills in the postoperative period, pro-
CBT to a control group. In total, 66 patients were moting important health behaviors, improving
randomly assigned to these three conditions. The compliance to life style adjustments, and early
exercise program included two weekly sessions dur- detection of risk behaviors. Efficacy results are not
ing 4 months. In the CBT condition weekly group available yet.
therapy aimed at life style modification was added A final recent and innovative application of CBT
&
to the exercise program. The control group only is virtual reality-enhanced CBT [33 ]. Although not
received routine clinic appointments and informa- investigated for bariatric surgery patients yet, results
tion meetings. Measurements were conducted at of a preliminary RCT comparing CBT, virtual reality-
baseline and post-CBT. Results showed that the enhanced CBT, and the standard behavioral pro-
exercise intervention had a positive health effect gram among 163-female patients with morbid obe-
including weight loss. The control group on the sity were promising regarding weight loss. CBT
contrary showed an increase of medical risk factors consisted of a 1-week inpatient program followed
during the waiting time for surgery. No statistically by five weekly group sessions and 10 biweekly indi-
significant differences were found between the in- vidual sessions. The virtual reality-enhanced CBT
tervention groups with and without CBT. group received the same program as the CBT group
To sum up, several studies on preoperative CBT but instead of 10 biweekly individual sessions, 10
interventions have shown positive effect on psycho- biweekly virtual reality sessions were offered. In 14
logical well-being and weight loss, but long- high risk virtual environments, like a supermarket or
term postoperative effects still need to be further restaurant, patients directly practiced coping, deci-
examined. sion-making, and problem-solving skills. Significant
Developing new treatment applications of CBT weight loss was achieved in all three groups. No
is important regarding the large number of patients significant differences between the three groups
and the need for long-term monitoring. Moreover, were found at posttreatment assessment, but the
face to face treatment can be problematic because virtual reality-enhanced CBT had a greater probabil-
of practical barriers such as limited mobility and ity of maintaining or improving weight loss at 1-year
limited accessibility of specialized bariatric surgery follow-up.
centers in some countries or rural areas. To improve Worth mentioning is a case series of three gastric
accessibility and cost-effective treatments, tele- band surgery patients receiving a 6-week virtual
phone, internet, and virtual reality-based applica- reality CBT protocol aimed at improving body
tions of CBT are being examined. image disorders and weight loss [34]. The CBT
A 6-week telephone-based CBT intervention was consisted of five group sessions focused on improv-
&
tested both pre and postsurgery [18 ,29]. In a pre- ing motivation to change and assertiveness and
&
operative pilot RCT [18 ], 47 patients were randomly 10 biweekly virtual reality sessions identical to the
assigned to standard preoperative care (routine clin- virtual reality intervention mentioned above. Post-
ic visits and information meetings) or six sessions of treatment results showed 15–20% further weight
tele-CBT. The tele-CBT protocol consisted of six reduction, apart from reduction of body dissatisfac-
weekly sessions focused on psychoeducation, self- tion, anxiety, and bulimic behaviors. Currently
monitoring, problem-solving, and goal setting [30]. these researchers are conducting an RCT.
Although the control group showed a small increase In addition to the development of both pre
in binge eating and emotional eating at postinter- and postoperative CBT packages for optimizing
vention, the CBT group experienced statistically results of bariatric surgery, in the past 3 years,
significant improvements with large effect sizes in several postoperative CBT interventions were spe-
eating behaviors and psychological well-being. In cifically developed for patients experiencing post-
a postoperative uncontrolled pilot study [29], operative weight regain. So far, those treatments
19 patients received 6-months postoperative six have only been examined in pilot studies, so no
sessions of the same tele-CBT. Results showed sig- definitive conclusions regarding their efficacy can
nificant reductions in binge eating, emotional be drawn.
4 www.co-psychiatry.com Volume 30 Number 00 Month 2017CE: Namrta; YCO/300605; Total nos of Pages: 6;
YCO 300605
Cognitive behavioral therapy Paul et al.
In a pilot study [35], pre and post-CBT results Currently, a longitudinal RCT in 128 patients on
of a 6-week group intervention based on CBT the effects of CBT, with follow-ups at 1, 3, and
and dialectical behavior therapy principles for 28 5-years postsurgery, is being conducted by the
patients experiencing postoperative weight regain authors [38].
showed statistically significant improvements for New techniques for applying CBT by telephone,
depressive symptoms, subjective binge eating, graz- internet, or virtual reality potentially make CBT
ing, and weight loss. Treatment included self-moni- more accessible and less costly, meeting the needs
toring, stress management, and diet skills as well as of treating a large number of patients worldwide
interventions for preventing emotion dysregulation and for long-term postoperative monitoring of
and changing disordered eating. patients.
Beaulac and Sandre [36] examined the efficacy
of an 8-week postsurgical CBT group among 17 Acknowledgements
patients experiencing difficulties in weight loss None.
and adjustment to postoperative status in a compa-
rable pilot study. Patients were assisted in develop- Financial support and sponsorship
ing coping strategies for managing stress and None.
conflicts, and in becoming more aware of triggers
for negative moods. Results showed improvements Conflicts of interest
in well-being and a decrease of psychological
There are no conflicts of interest.
symptoms and distress, although statistically not
significant.
&&
Robinson et al. [37 ] examined a skills-based REFERENCES AND RECOMMENDED
postoperative intervention aimed at improving READING
dietary adherence among 22 postoperative patients Papers of particular interest, published within the annual period of review, have
been highlighted as:
at high risk for suboptimal weight loss outcomes. & of special interest
Psychological skills deficits associated with sub- && of outstanding interest
optimal weight loss outcomes, such as a lack of self 1. Ng M, Fleming T, Robinson M, et al. Global, regional, and national prevalence
monitoring and assertiveness, are assessed and of overweight and obesity in children and adults during 1980-2013: a
systematic analysis for the Global Burden of Disease Study 2013. Lancet
trained. 2014; 384:766–781.
2. NCD Risk Factor Collaboration (NCD-RisC). Trends in adult body-mass index
in 200 countries from 1975 to 2014: a pooled analysis of 1698 population-
based measurement studies with 19.2 million participants. Lancet 2016;
CONCLUSION 387:1377–1396.
3. Lim SS, Vos T, Flaxman AD, et al. A comparative risk assessment of burden of
Research focused on identifying predictors for disease and injury attributable to 67 risk factors and risk factor clusters in 21
weight loss after bariatric surgery has shown that regions, 1990–2010: a systematic analysis for the Global Burden of Disease
Study 2010. Lancet 2013; 380:2224–2260.
post rather than preoperative behaviors predict 4. Erskine HE, Whiteford HA, Pike KM. The global burden of eating disorders.
postoperative weight loss. Especially postsurgical Curr Opin Psychiatry 2016; 29:346–353.
5. Marcus MD, Wildes JE. Disordered eating in obese individuals. Curr Opin
disordered eating behaviors, eating disorders, and Psychiatry 2014; 27:443–447.
psychopathology have been found to be associated 6. Gloy VL, Briel M, Bhatt DL, et al. Bariatric surgery versus nonsurgical
treatment for obesity: a systematic review and meta-analysis of randomized
with less optimal weight loss results. This highlights controlled trials. BMJ 2013; 347:f5934.
the importance of continuous and long-term moni- 7. Adams TD, Davidson LE, Litwin SE, et al. Health benefits of gastric bypass
surgery after 6 years. JAMA 2012; 308:1122–1131.
toring of these risk factors and behaviors postopera- 8. Courcoulas AP, Christian NJ, Belle SH, et al., Longitudinal Assessment of
tively and early intervention in case of stagnation of Bariatric Surgery (LABS) Consortium. Weight change and health outcomes at
3 years after bariatric surgery among individuals with severe obesity. JAMA
weight loss. 2013; 310:2416–2425.
Although empirical evidence is still scarce 9. Zhang Y, Wang J, Sun X, et al. Laparoscopic sleeve gastrectomy versus
laparoscopic Roux-en-Y gastric bypass for morbid obesity and related
results show that CBT is effective in reducing disor- comorbidities: a meta-analysis of 21 studies. Obes Surg 2015; 25:19–26.
dered eating behavior and depression in bariatric 10. Conceição E, Pinto-Bastos A, Brandão I, et al. Loss of control eating and
weight outcomes after bariatric surgery: a study with a Portuguese sample.
patients. Most studies conducted so far lack long- Eat Weight Disord 2014; 19:103–109.
term follow-ups, lack important outcome variables 11. Conceição E, Mitchell JE, Vaz AR, et al. The presence of maladaptive eating
behaviors after bariatric surgery in a cross sectional study: importance of
(e.g., only weight loss and no psychological varia- picking or nibbling on weight regain. Eat Behav 2014; 15:558–562.
bles or vice versa) and were uncontrolled or had 12. Mitchell JE, King WC, Courcoulas A, et al. Eating behavior and eating
disorders in adults before bariatric surgery. Int J Eat Disord 2014; 48:
small sample sizes. Also the relationship between 215–222.
reduction of risk factors by CBT and long-term 13. Green DD, Engel SG, Mitchell JE. Psychological aspects of bariatric surgery.
Curr Opin Psychiatry 2014; 27:448–452.
weight loss results need further research. Longitu- 14. Sheets CS, Peat CM, Berg KC, et al. Post-operative psychosocial predictors
dinal controlled studies with larger samples are of outcome in bariatric surgery. Obes Surg 2015; 25:330–345.
15. Rudolph A, Hilbert A. Post-operative behavioural management in bariatric
needed to examine the long-term effects of CBT surgery: a systematic review and meta-analysis of randomized controlled
on weight loss and psychological well-being. trials. Obes Rev 2013; 14:292–302.
0951-7367 Copyright ß 2017 Wolters Kluwer Health, Inc. All rights reserved. www.co-psychiatry.com 5CE: Namrta; YCO/300605; Total nos of Pages: 6;
YCO 300605
Eating disorders
16. Gade H, Friborg O, Rosenvinge JH, et al. The impact of a preoperative 27. Hindle A, de la Piedad Garcia X, Brennan L. Early postoperative psychosocial
cognitive behavioural therapy (CBT) on dysfunctional eating behaviours, & and weight predictors of later outcome in bariatric surgery: a systematic
affective symptoms and body weight 1 year after bariatric surgery: a rando- literature review. Obes Rev 2017; 18:317–334.
mised controlled trial. Obes Surg 2015; 25:2112–2119. This is the first systematic review regarding early postoperative variables predictive
17. Bond DS, Vithiananthan S, Thomas JG, et al. Bari-active: a randomized of later weight and psychosocial outcomes in bariatric surgery showing that early
controlled trial of a preoperative intervention to increase physical activity in weight loss trajectory is the most consistent predictor of more successful medium-
bariatric surgery patients. Surg Obes Relat Dis 2015; 11:169–177. term weight outcome.
18. Cassin SE, Sockalingam S, Du C, et al. A pilot randomized controlled trial of 28. Bond DS, Thomas JG, King WC, et al. Exercise improves quality of life in
& telephone-based cognitive behavioural therapy for preoperative bariatric bariatric surgery candidates: Results from the Bari-Active trial. Obesity (Silver
surgery patients. Behav Res Ther 2016; 80:17–22. Spring) 2015; 23:536–542.
The controlled pilot study provides preliminary evidence for improving eating 29. Sockalingam S, Cassin SE, Wnuk S, et al. A pilot study on telephone cognitive
psychopathology and depression in bariatric surgery candidates by using tele- behavioral therapy for patients six-months post-bariatric surgery. Obes Surg
phone-based CBT. 2016; 26:1–6.
19. Marcon ER, Baglioni S, Bittencourt L, et al. What is the best treatment before 30. Cassin SE, Sockalingam S, Wnuk S, et al. Cognitive behavioral therapy for
bariatric surgery? Exercise, exercise and group therapy, or conventional bariatric surgery patients: preliminary evidence for feasibility, acceptability,
waiting: a randomized controlled trial. Obes Surg 2017; 27:763–773. and effectiveness. Cogn Behav Pract 2013; 20:529–543.
20. Wimmelmann CL, Dela F, Mortensen EL. Psychological predictors of weight 31. Zhang MW, Ho RC, Cassin SE, et al. Online and smartphone based cognitive
loss after bariatric surgery: a review of the recent research. Obes Res Clin behavioral therapy for bariatric surgery patients: initial pilot study. Technol
Pract 2014; 8:e299–e313. Health Care 2015; 23:737–744.
21. Meany G, Conceição E, Mitchell JE. Binge eating, binge eating disorder and 32. Conceição EM, Machado PP, Vaz AR, et al. APOLO-Bari, an internet-based
loss of control eating: effects on weight outcomes after bariatric surgery. Eur program for longitudinal support of bariatric surgery patients: study protocol
Eat Disord Rev 2014; 22:87–91. for a randomized controlled trial. Trials 2016; 17:114.
22. Conceição EM, Mitchell JE, Pinto-Bastos A, et al. Stability of problematic 33. Manzoni GM, Cesa GL, Bacchetta M, et al. Virtual reality-enhanced
&& eating behaviors and weight loss trajectories after bariatric surgery: a long- & cognitive-behavioral therapy for morbid obesity: a randomized controlled
itudinal observational study. Surg Obes Relat Dis 2017; 13:1063–1070. study with 1 year follow-up. Cyberpsychol Behav Soc Netw 2016; 19:
The longitudinal study shows that preoperative problematic eating behavior is not a 134–140.
significant predictor for postsurgical weight loss. Postoperative problematic eating This is the first controlled study using virtual reality-enhanced CBT for patients with
behavior is a significant predictor of different weight loss trajectories after bariatric morbid obesity showing that virtual reality-enhanced CBT is effective in further
surgery. improving weight loss at 1 year.
23. Mitchell JE, Christian NJ, Flum DR, et al. Postoperative behavioral variables and 34. Cárdenas-López G, Torres-Villalobos G, Martinez P, et al. Virtual reality for
&& weight change 3 years after bariatric surgery. JAMA Surg 2016; 151: 752–757. improving body image disorders and weight loss after gastric band surgery: a
The longitudinal cohort study shows that postoperative eating and weight control case series. Stud Health Technol Inform 2014; 196:43–47.
behaviors, many of which are potentially modifiable, may improve weight loss 35. Himes SM, Grothe KB, Clark MM, et al. Stop regain: a pilot psychological
substantially following bariatric surgery. intervention for bariatric patients experiencing weight regain. Obes Surg
24. Konttinen H, Peltonen M, Sjöström L, et al. Psychological aspects of eating 2015; 25:922–927.
behavior as predictors of 10-y weight changes after surgical and conventional 36. Beaulac J, Sandre D. Impact of a CBT psychotherapy group on postoperative
treatment of severe obesity: results from the Swedish obese subjects inter- bariatric patients. Springerplus 2015; 4:764.
vention study. Am J Clin Nutr 2015; 101:16–24. 37. Robinson AH, Adler S, Darcy AM, et al. Early Adherence Targeted Therapy
25. White MA, Kalarchian MA, Levine MD, et al. Prognostic significance of && (EATT) for postbariatric maladaptive eating behaviors. Cogn Behav Pract
depressive symptoms on weight loss and psychosocial outcomes following 2016; 23:548–560.
gastric bypass surgery: a prospective 24-month follow-up study. Obes Surg Early adherence targeted therapy is a new intervention for postoperative patients at
2015; 25:1909–1916. risk of poor weight loss outcomes and this pilot study shows preliminary positive
26. Devlin MJ, King WC, Kalarchian MA, et al. Eating pathology and experience outcomes.
& and weight loss in a prospective study of bariatric surgery patients: 3-year 38. Paul L, van Rongen S, van Hoeken D, et al. Does cognitive behavioral therapy
follow-up. Int J Eat Disord 2016; 49:1058–1067. strengthen the effect of bariatric surgery for obesity? Design and methods
The prospective study shows that postoperative loss of control eating, hunger and of a randomized and controlled study. Contemp Clin Trials 2015; 42:
eating disease (also BED) are related to less weight loss. 252–256.
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